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Abstract

Introduction: Occlusion of cervical internal carotid artery (ICA) was associated with impaired cerebral perfusion, which may lead to ischemic cerebral symptoms and hemodynamic infarcts. Neither surgical nor endovascular revascularization has been demonstrated to have clinical benefit in this population. We report technical detail and clinical results of the first series of endovascular recanalization for symptomatic cervical ICA occlusion.

Methods and Results: Endovascular recanalization was attempted in 30 patients of known ICA occlusion with recurrent ischemic cerebral symptoms (27 men; age 72.1±8.0 years, range 48 to 85). Strategies and devices for coronary occlusion intervention were applied, including micro-catheter supported tapered-tip stiff coronary guide wires. Contra-lateral ICA stenosis was found in 9 (30%). All patients underwent independent neurological and duplex ultrasound follow-up. Overall technical success rate was 73% (22/30). No neck hematoma, intracranial hemorrhage, or hyperperfusion was noted. One (3.3%) fatal brainstem infarction occurred 1 day after a successful procedure, with angiographically proven acute basilar artery occlusion and patent ICA stent. 15 from 22 successfully recanalized patients had reversed ophthalmic artery flow before procedure and normalization of flow pattern was found in 12 of them after revascularization(80%, 12/15). There was no new cerebral ischemic event or neurological death for a mean follow-up of 16.1±18.5 months.